10

Introduction

Emotional regulation is used in occupational performance to control an individual’s emotional states (Scheinholz, 2010, p.345-357). It includes recognizing and modifying emotions and feelings in response to emotional triggers (Santomauro, et. al., 2017). For people who can not successfully regulate their emotions, such as individuals with Autism, they are associated with increased mood disorders, especially depression and anxiety (Santomauro, et. al., 2017). In addition, as stated in chapter 2, individuals with Autism have difficulty with Theory of Mind. They are unable to determine what another person is feeling or thinking, which can lead to frustration and confusion. An occupational therapist can provide an individual with Autism the skills needed to increase emotional regulation in order to increase social participation and other meaningful occupations.

Theory

When the processing and integrating of sensory information interferes with a child’s performance, occupational therapy practitioners may used sensory based intervention or sensory integration approach to support a child’s participation in daily activities. “Sensory integration involves perceiving, modulating, organizing, and interpreting these sensations to optimize occupational performance and participation (Ayres, 2005).” When the sensory systems are regulated and appropriately functioning, they can contribute to pertinent outcomes in social-emotional, physical and motor, communication, self-care, cognitive, and adaptive skills development. Well-regulated and appropriately functioning sensory systems contribute to important outcomes in social-emotional, physical and motor, communication, self-care, cognitive, and adaptive skills development (Schaff & Smith Roley, 2006). Individuals learn about their environment and body through integrated sensory systems: olfactory, gustatory, visual, auditory, vestibular, proprioceptive, and tactile. Without intervention, issues in sensory integration continue into adulthood and have been reported to impact work performance, relationships, and general functional abilities (Kinnealey, Koenig, & Smith, 2011).

Evidence

In a qualitative study done by Santomauro, et. al. (2017), seven focus groups consisting of adolescents and young adults diagnosed with Autism found that depression and anxiety were perceived as the most experienced distressing issues. In addition, the participants discussed having difficulties with emotional awareness. In another study done by Samson, et. al. (2012), in regards to emotional regulation, individuals with high functioning Autism used less cognitive reappraisal and used suppression, which is a less adaptive emotional regulation strategy, as compared to typical developing individuals. Occupational therapists have the knowledge and skills to integrate emotional regulation strategies into therapy sessions to help reduce the prevalence of depression and anxiety for individuals with Autism.

Case Study

Sam is an 18-year-old boy who is diagnosed with autism spectrum disorder. He is currently a freshman at a local college studying marine biology. He lives at home with mom, dad, and sister.

Sam is struggling with his new college environment. He has become overwhelmed with the large crowds and fast pace on the college campus. Sam was referred to occupational therapy services after disrupting his crowded auditorium lectures multiple times.

Intervention Plan

Problem Statement

Client is having difficulty with participation in formal education due to his inability to process sensory information effectively.

Long term goals

1- Client will be able to sit through a 50 minute lecture in a college auditorium without having disruptive behaviors for participation in formal education in 4 weeks.

2-  Client will independently comply with 4 out of 4  sensory diet techniques in order to increase emotional regulation for participation in formal education in one month.

Short term goals

1-Client will sit through a 20 minute study group session in the library without having disruptive behaviors in order to participate during school lectures in two weeks.

2- Client will comply with 2 out of 4  sensory diet techniques in order to increase emotional regulation in two weeks.

3-  Client will identify a quiet space on campus to visit before attending lecture in order to increase participation in formal education in one week.

Intervention format

Individual and community based

Setting

Sam will visit the occupational therapist at the clinic, twice for 45 minute sessions. The therapist will also conduct therapy sessions on Sam’s college campus.

Supplies

Supplies in therapists sensory bin.

Agenda & description

• Therapist introduces themself to Sam and explains what an occupational therapist does (7 mins)
• Therapist presents sensory bin to identify which sensory items that he enjoys and finds calming.  (30 mins)
  • Therapist introduced Sam to three youtube videos with different calming sounds for him to identify which sound he finds the most soothing.
  • Therapist brought three different aromatherapy smells for Sam to identify which smell he enjoys the most and finds calming
  • Therapist brought Sam a fidget spinner, fidget toy, gel grips for pens/ pencils, and play- doh for him to identify which tactile sensory items helps him with attention and emotional regulation.
• Sam wrote list of sensory items he identified as soothing so he can incorporate in his daily life. (3mins)

Documentation

S- Sam mentioned feeling embarrassed of his outburst during last weeks lecture. He described that he got overwhelmed when everyone started taking at the same time and he felt he could not keep up.

O-During the session Sam was exposed to different sensory items. He listened to 3 different types of sound on youtube, 3 aromatherapy smells and 3 tactile sensory items. He was then asked to use the Likert scale to identify how soothing each item was, 1 being not soothing and 5 being extremely soothing.

Youtube video 1: 2

Youtube video 2: 3

Youtube video 3: 3

Aromatherapy smell 1:  1

Aromatherapy smell 2:  5

Aromatherapy smell 3:  4

Fidget Spinner:  5

Fidget Toy:   5

Gel grips for pens:   3

A- Throughout this therapy session, Sam was able to identify auditory, olfactory and tactile sensory items that he finds soothing that he can incorporate in his daily life. This shows good potential for improving self regulation skills. Sam will benefit from creating a sensory diet to implement during his time in college so that he can become independent and successful in his studies.

P- During the next session Sam and the therapist will create a sensory diet based on soothing techniques identified during this session. Therapist recommends for Sam to continue therapy sessions, twice a week, for 45 minutes to continue working on his emotional regulation deficits.

References

Ayres, A.J. (2005). Sensory integration and the child. Los Angeles: Western Psychological Services.

Brown, C., Stoffel, V. C., & Munoz, J. P. (2010). Emotional Regulation.Occupational therapy in mental health : a vision for participation (p.345-357). Retrieved from http://ebookcentral.proquest.com

Kinnealey, M., Koenig, K.P., & Smith, S. (2011). Relationships between sensory modulation and social supports and health related quality of life.

Samson, A. C., Huber, O., & Gross, J. J. (2012). Emotion regulation in Asperger’s syndrome and high-functioning autism. Emotion, 12(4), 659.

Santomauro, D., Sheffield, J., & Sofronoff, K. (2017). Investigations into emotion regulation difficulties among

adolescents and young adults with autism spectrum disorder: A qualitative study. Journal of Intellectual &

Developmental Disability, 42(3), 275-284.

Schaff, R.C., & Smith Roley, S. (2006). Sensory integration: Applying clinical reasoning to practice with diverse

population. Austin, TX: Pro-Ed.